Disappearance of humoral thyroid autoimmunity after complete removal of thyroid antigens

Article Abstract:

Background: The development of antibodies to thyroid peroxidase, thyroglobulin, and thyroid-stimulating hormone (TSH) receptor is a main feature of autoimmune thyroid diseases. Objective: To investigate whether complete removal of thyroid antigens results in the abatement of humoral thyroid autoimmunity. Design: Retrospective chart review study of patients treated and monitored with a standard prospective protocol. Setting: University hospital in Pisa, Italy, between 1976 and 1994. Patients: 182 patients with differentiated thyroid carcinoma and serum antibodies to thyroid peroxidase, thyroglobulin, or TSH receptor due to coexistent clinical Hashimoto thyroiditis, Graves disease, or focal thyroiditis. Intervention: Total thyroidectomy and radioiodine treatment to ablate residual or metastatic thyroid tissue. Regular follow-up with iodine-131 whole-body scanning and serum thyroglobulin measurement. Mean follow-up (+/-SD) was 10.1 +/- 4.1 years (range, 4 to 20 years). Measurements: Serum antibodies to thyroid peroxidase, thyroglobulin, and TSH receptor. Results: Thyroid peroxidase, thyroglobulin, and TSH-receptor antibodies progressively disappeared after the initial treatment. The median disappearance time was 6.3 years for thyroid peroxidase antibodies and 3.0 years for thyroglobulin antibodies. There was a statistically significant correlation between the disappearance of thyroid tissue and that of thyroid antibodies. The coexistence of Hashimoto thyroiditis or Graves disease with thyroid cancer did not modify the pattern of disappearance of thyroid antibody compared with patients with focal autoimmune thyroiditis. Conclusions: Complete ablation of thyroid tissue with its antigenic components results in the disappearance of antibodies to all major thyroid antigens, thus supporting the concept that continued antibody production depends on the persistence of autoantigen in the body.

Care and treatment, Patient outcomes, Autoantigens, Thyroiditis, Autoimmune, Autoimmune thyroiditis, Author Abstract

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Methimazole and serum thyroid hormone concentrations in hyperthyroid patients: effects of single and multiple daily doses

Article Abstract:

Thionamide drugs, which inhibit the production of the thyroid hormones, are administered in divided doses because they are active in the blood for only short periods of time. However, it has recently been shown that the effect of the thionamides depends on how long they remain active in the thyroid gland, rather than in the blood. The thionamide drug methimazole has been shown to be active in the thyroid for 20 hours, but only 6.8 hours in the blood. It has been recommended that a single dose of methimazole be given daily. The effect of a single dose was compared with that of divided doses in 18 patients with Graves disease, a disorder characterized by increased levels of thyroid hormones. It was found that the levels of the thyroid hormones thyroxine and triiodothyronine, as well as the patients' heart rates decreased to the same extent with both administration schedules. By day 30 of treatment, the patients had thyroid hormone levels and heart rates that were in the normal range. Thus, both single and divided doses of methimazole were equally effective in the treatment of hyperthyroidism. The advantage of a single dose of methimazole is that a single dose is easier to administer, as the drug is given as an injection into the peritoneal cavity, and thus more patients might follow the treatment protocol. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drug therapy, Dosage and administration, Thyroid diseases, Hyperthyroidism, Methimazole

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Cigarette smoking and treatment outcomes in Graves ophthalmopathy

Article Abstract:

Cigarette smoking contributes to the progression of Graves ophthalmopathy and may reduce the effectiveness of treatment for the disease. Graves disease is a type of hyperthyroidism, and some patients develop bulging eyes and other ocular symptoms. Researchers evaluating the effects of smoking on the outcomes of 450 patients treated for Graves ophthalmopathy. Eye symptoms progressed in 6% of nonsmokers and 23% of smokers. Radiation and corticosteroid drug therapies were effective in 94% of nonsmokers and 68% of smokers with Graves ophthalmopathy.

Development and progression, Smoking, Thyroid eye disease

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